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General NPI Number Information
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NPI Number | 1023573680
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Entity Type | Organization
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Legal Business Name | BEHAVIOR AND COUNSELING CENTER LLC
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 604 ROXBOROUGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1709
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Country | US
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Telephone | 908-489-8674
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Fax |
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Provider Business Mailing Address
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Address Line | 604 ROXBOROUGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1709
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Country | US
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Telephone | 908-489-8674
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | MICHAEL CLEMENTE
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Credential | BCBA, LBS, LPC
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Telephone | 215-452-6274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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